Insurance fraud detection: A statistically validated network approach

• Published in: The Journal of risk and insurance Vol. 90; no. 2; pp. 381 - 419
• Main Authors: Tumminello, Michele, Consiglio, Andrea, Vassallo, Pietro, Cesari, Riccardo, Farabullini, Fabio
• Format: Journal Article
• Language: English
• Published: Malvern Blackwell Publishing Ltd 01.06.2023
• Subjects: bipartite networks; insurance fraud detection; statistically validated networks
• ISSN: 0022-4367; 1539-6975; 1539-6975
• DOI: 10.1111/jori.12415

Fraud is a social phenomenon, and fraudsters often collaborate with other fraudsters, taking on different roles. The challenge for insurance companies is to implement claim assessment and improve fraud detection accuracy. We developed an investigative system based on bipartite networks, highlighting the relationships between subjects and accidents or vehicles and accidents. We formalize filtering rules through probability models and test specific methods to assess the existence of communities in extensive networks and propose new alert metrics for suspicious structures. We apply the methodology to a real database—the Italian Antifraud Integrated Archive—and compare the results to out‐of‐sample fraud scams under investigation by the judicial authorities.